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Similar rates of medial elbow changes in Little Leaguers may imply that the roentgenological changes of the medial epicondyle could be an adaptive yet physiological reaction to the excessive valgus stress of throwing. The higher incidence of medial epicondylar separation and fragmentation in catchers that has not been reported before may be secondary to the increased stress placed on the elbow when throwing from the squatting position.

Various assessment tools have been proposed for evaluation of shoulder function. Analyses of comparability, validity, and reliability among shoulder assessment tools are lacking. The purpose of our investigation was to compare the results of three commonly used shoulder assessment tools in the evaluation of a specific shoulder condition. Seventy-two fullthickness rotator cuff tears were treated with an open rotator cuff repair from 1986-1993. The average age of the patients at surgery was 58 years (range, 24-92 years). The median duration of followup at the time of evaluation for this study was 55 months (range, 24-102 months; standard deviation, 22 months). Correlation among the results of the UCLA, Constant-Murley, and the Simple Shoulder Test scales was fair (range, 0.66-0.76). More importantly, the three systems were evaluated for their ability to accurately predict improved motion, strength, and patient satisfaction. The Simple Shoulder Test and the Constant-Murley scales showed the highest positive predictive values. The Simple Shoulder Test is a patient-based self-assessment device that easily can be incorporated into a busy clinical practice, providing outcome data comparable with complex evaluation systems when evaluating the results of rotator cuff repair.

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W e performed MRI on 16 patients who had had reconstruction of the anterior cruciate ligament (ACL) with a mid-third bone-patellar-tendon-bone autograft. Our aim was to assess the tendon and the site of its insertion at an average of seven years after the original operation. In four of these patients biopsies were taken from the donor site when they had revision of their original operation.MRI showed reconstitution of the tendon into the patellar defect with no evidence of bone formation. Six patients had a persistent defect in the patellar tendon itself. Histological examination of the biopsies of the donor site showed an indirect pattern of insertion with absence of the normal fibrocartilage zone. These morphological changes may adversely affect the biomechanical properties of the healed donor site and we suggest that another graft taken from this site may not be suitable for use in a further operation for reconstruction of the ACL.

As in this case study of a snowboarder, the typical history for distal biceps brachii rupture involves a single traumatic event, an audible popping sound, and intense pain. The physical exam will reveal ecchymosis in the antecubital area and weakness with both supination and elbow flexion; the distal biceps brachii tendon will not be palpable. Though distal biceps rupture is far less common than its proximal counterpart, primary care physicians should be aware of the diagnostic criteria. Referral for surgical treatment is necessary to preserve elbow flexion and supination strength.

In brief Corticosteroid injections are sometimes used to treat Achilles tendinitis after conservative measures such as anti-inflammatory medications, rest, ice massage, and immobilization have failed. Some research suggests that corticosteroid injections can lead to tendon rupture, though other investigations have not shown a correlation. A case report detailing partial Achilles tendon rupture after corticosteroid injection renews concern about the risks of this treatment.